Interesting patient-oriented website brought to my attention @ doctorbyyourside.org. Not clear who organized it but it appears to be an honest attempt at sifting through the propaganda and defining who we are and how we got there. Undoubtedly a response to the increasingly aggressive stance by the AANA to equate CRNAs to physicians. Take a looksee.
Quite an inflammatory post over there at Slate.com. Essentially the same same CRNA=MD drivel that has been coming out this past year. This time it is directed at interventional pain physicians. The factual errors will make any reader cringe regardless of your slant. The comments are also worth a quick scroll.
I hesitate to highight such nonsense but I figured its good to know what is being said about you. Timmy Noah should have his crayons and scrap paper taken away.
The Colorado state board has spoken and MDs, you are eliminated. Ok not eliminated, but close enough. From the Governer’s press release:
Gov. Bill Ritter announced today that Colorado will opt out of a federal Medicare rule that requires physician supervision in rural hospitals for certified registered nurse anesthetists. Colorado will join 15 other states – many of them large, Western and rural – that have opted out of the rule since it became an option in 2001.
I’d include more of the press release but the part about enhancing patient safety makes me sick. I would love to see a politician be honest for once. I mean really, if patient safety were priority number one does it really make sense to turn your life over to a nurse over an MD. Yes, I know the joke of study published recently would like everyone to believe that safety is the same. I call BS on that one.
Airstrip Technologies out of San Antonio,TX recently unveiled a remote monitoring app for the iPhone and many other portable and non portable devices:
From the company website:
AirStrip Technologies, a pioneer in mobile medical software applications, today announced that it has received U.S. Food and Drug Administration (FDA) clearance to market the AirStrip Remote Patient Monitoring solution (RPM), including AirStrip RPM CRITICAL CARE and AirStrip RPM CARDIOLOGY.
With FDA clearance in place, AirStrip now extends its virtual real time remote patient monitoring technology to a broad array of acute patient clinical settings, which include the intensive care unit, the emergency department, the operating room, the neonatal ICU, and virtually any other care environment.
The AirStrip RPM solution allows clinicians unprecedented remote access to critical patient data in virtual real time. Medical professionals will use their smartphones to see vital signs, critical waveform data and other clinical information, which is sent directly from the hospital and can be accessed from virtually anywhere a cell-phone or other wireless connection is available.
Notice the lack of an anesthesia-related uses in the marketing materials? Me too. My guess is that the idea of remote monitoring in the OR is still a ways off. The app is much more suited to the critical care provider monitoring from afar. The OB app which can display FHR tracings also seems the most immediately useful. The cost basis for implementation is not discussed and I fear too high to retrofit most ICUs, ORs and/or L&D suites. Maybe if they can demonstrate a cost savings in personnel (i.e. crnas) then perhaps they may have at viable product. :)
The debate rages on. An AANA funded study was recently published in the “journal” Health Affairs which found similar outcomes between unsupervised CRNAs and MDs. Despite many a flaw, the AANA is using this as ammunition to push for solo practice.
Not surprisingly the ASA has released a statement:
The American Association of Nurse Anesthetists (AANA) – sponsored paper published in the August 2010 issue of Health Affairs, titled “No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians,”1 is an advocacy manifesto masquerading as science and does a disservice to the public. It makes dangerous public policy recommendations on the basis of inadequate data, flawed analysis and distorted facts.
Summary here from Boston.com.
Another good summary from WSJ here.
The ASA does indeed have a point in that using data derived from medical billing is a flawed method of reporting outcomes and any conclusions derived from these studies are useless.
Update 9/7/10:
In response to the impending Colorado opt-out the NY Times Editorial staff has chimed in. Eagerly awaiting the ASA letter to the editor response. Stay tuned.
Update 9/11/10:
As expected there letters published in the NY Times in response to the above mentioned editiorial. See them here.
A relatively muted response from the ASA and the expected response from the American Academy of Nursing.
ASA PAC donations accepted here.
Any third year medical student can cite the ROAD mnemonic which guides the newbs to which fields will lead them to a career full of easy lifestyles and fast money. Radiology, Ophthalmology, Anesthesiology and Dermatology. With health care reform coming down the pike it may be time to change the mnemonic to the CNP to happiness. Crna, Nurse Practitioner, Physician Assistant…I was never good at mnemonics anyway.
The obvious solution is substituting non-MD anesthesia providers for physician anesthesiologists. The American Association of Nurse Anesthetists (AANA) has long maintained that its members, as well as other advance practice nurses (APRNs), can work independently of MDs.The fact is they are right.
As an MD blogger I have my own built-in biases regarded the role of the so-called “mid-level provider”. This blog, while enormously biased at times, will remain neutral…with sarcastic undertones of course.
Once again the power of a strong lobby is attempting to change the face of health care as we know it…
From Anesthesiology News:
Extending the scope of practice for certified registered nurse anesthetists (CRNAs) is on the agenda in several states this year. Efforts to redefine or expand the role of CRNAs are coming mostly through state legislatures, with at least one state board of nursing involved.
So let me get this straight, you want to practice independently, do interventional procedures and have perscriptive authority? Uhh, if that ain’t “practicing medicine”, I’m not sure what is…oops! there goes neutrality. Comments?
Read.
